From the Guidelines
A person with signs and symptoms of a concussion should be immediately removed from activity and not allowed to return to activity until evaluated by a healthcare professional. This is based on the most recent guidelines from the American Heart Association and American Red Cross, as outlined in the 2024 guidelines for first aid 1. The protocol for managing concussions involves several key steps:
- Immediate removal from activity to prevent further injury
- Assessment by a healthcare professional to determine the severity of the concussion
- Gradual return to activities, starting with light aerobic exercise, followed by sport-specific exercise, non-contact training drills, full-contact practice (after medical clearance), and finally return to competition
- Each step should take at least 24 hours, and if symptoms return, the person should go back to the previous step
- Rest is crucial in the first 24-48 hours, both physical and cognitive (limiting screen time, reading, and mentally demanding tasks)
- Medications like acetaminophen may be used for headache, but avoid NSAIDs like ibuprofen initially due to bleeding risk
- Children and adolescents typically need more conservative management and longer recovery times than adults, as recommended by the American Academy of Pediatrics 1. It's also important to note that for severe head injuries, such as those with loss of consciousness, worsening headache, vomiting, altered mental status, seizures, visual changes, swelling, or deformities of the scalp, EMS should be activated immediately 1.
From the Research
Concussion Protocol Overview
- The concussion protocol is a set of guidelines used to manage and treat concussions, with the goal of reducing recovery time and minimizing the risk of further injury.
- Studies have shown that immediate removal from play after a concussion is associated with shorter clinical recovery and less severe symptoms 2, 3.
Removal from Play
- Immediate removal from play after a concussion has been shown to be a protective factor associated with less severe acute symptoms and shorter recovery 2.
- Athletes who continue to play with a concussion are at a higher risk of protracted recovery and may exhibit worse neurocognitive and greater symptoms 3.
- A study found that athletes who were immediately removed from play took an average of 22 days to recover, compared to 44 days for those who continued to play 3.
Rest and Rehabilitation
- The effectiveness of acute cognitive and physical rest on concussion recovery is unclear, with some studies suggesting that it may not improve recovery time 4.
- Exercise has been recommended as an appropriate therapy for adolescents with acute concussion, but the evidence for other therapeutic interventions is limited 5.
- A structured approach to rehabilitation, including subsymptom threshold aerobic exercise, cervical physical therapy, and vestibulo-ocular rehabilitation, may be beneficial for individuals with concussion and persistent postconcussive symptoms 6.
Return to Activity
- The timing of return to activity after a concussion is critical, with studies suggesting that premature return to play may increase the risk of further injury and prolong recovery time 2, 3.
- A gradual return to activity, with a focus on symptom management and monitoring, is recommended to minimize the risk of complications and promote safe recovery 5, 6.